Provider Demographics
NPI:1528168200
Name:CROUCH, MATTHEW JAMES (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JAMES
Last Name:CROUCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21 BRIDGEWAY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72113-9514
Mailing Address - Country:US
Mailing Address - Phone:501-771-1500
Mailing Address - Fax:501-771-8542
Practice Address - Street 1:21 BRIDGEWAY RD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72113-9514
Practice Address - Country:US
Practice Address - Phone:501-771-1500
Practice Address - Fax:501-771-8542
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-47592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5H057226Medicare PIN
AR5H105Medicare PIN